Gastric Bypass vs Lap Band
A Weight Loss Surgery Comparison

Compare weight loss surgeries:
gastric bypass vs lap band

Weight loss surgery (also called bariatric surgery) is increasingly being recommended and accepted as a treatment for obesity...and for good reasons.

Recent studies show that the average weight loss following weight loss surgery is almost 90 pounds (40 kg)...sufficient to significantly improve and in some cases completely alleviate illnesses such as diabetes, hypertension, high cholesterol, and sleep apnea (5).

It's not surprising that the frequency of bariatric surgery has increased 10 times over in the past 10 years!

Weight Loss Surgery Comparison:
Gastric Bypass vs Lap Band

The two most popular weight loss surgeries performed are the gastric bypass (also called Roux-en-Y) and laparoscopic adjustable gastric banding (also called gastric lap band, stomach band, or lap band).

Both of these methods work by physically restricting the amount of food a person can eat, but gastric bypass additionally causes malabsorption of food.

Compare Weight Loss Surgeries:
How Different Surgeries Work

With gastric banding, an adjustable inflatable tube is placed around the stomach near the top where it joins the esophagus, essentially creating a smaller stomach that can hold only alimited amount of food.

In a gastric bypass, a smaller upper stomach is surgically created and attached directly to the small intestine, so that food never enters the main portion of the stomach and the upperpart of the small intestine.

The Roux-en-Y procedure has been around longer than gastric banding and is currently the standard method used for surgical weight loss in the U.S. However, some of the advantages of gastric banding have led to a rapid increase in its popularity among both patients and surgeons.

Gastric Bypass vs Lap Band

Gastric banding is reversible and is a less invasive form of surgery than gastric bypass, which is a major and permanent surgical intervention.

However, there has not been a great deal of research comparing the two methods in terms of effectiveness and safety.

Dr. Jeffrey Tice and a team of researchers from the University of California at San Francisco recently conducted a review of the available research literature regarding the relative advantages of these two procedures.

Their report, "Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures," published in The American Journal of Medicine in 2008, arrives at some strong conclusions and recommendations (6).

Comparing the Outcomes

Dr. Tice and his colleagues examined all the studies they could find from 1966 to 2007 that involved comparison of patient outcomes following gastric banding and gastric bypass surgery.

In the end, they reviewed 14 trials that not only compared the two directly but also reported weight loss outcomes and complications of the surgeries.

The patients who were studied had an average age of 40, a pre-operative BMI of 45, and were mostly female (80%).

Gastric Bypass vs Lap Band: Weight Loss

Patients who underwent Roux-en-Y gastric bypass lost considerably more weight...25% more on average.

Gastric Bypass vs Lap Band: Disease Related Illnesses

Two studies found that gastric bypass patients were also 25% more likely to be cured of their obesity-related illnesses (7, 8). Another study found that all of the most severely obese patients (BMI of 50+) who had gastric bypass eliminated their diabetes, as opposed to only 40% of those with gastric bands (9).

Gastric Bypass vs Lap Band: Complications

Any surgery involves a risk of complications during or immediately after the procedureand sometimes in the long term as well.

Gastric banding procedures were found to have the advantage in their immediate surgical outcomes. The actual surgery took less time (more than an hour less) and hospital stays were about 2 days shorter than the gastric bypass process.

Most important, while mortality rates were low for both procedures, the death incidence was lower for laparoscopic adjustable gastric banding. In the long term, on the other hand, the gastric banding patients experienced more complications, including the need for further operations.

Gastric Bypass vs Lap Band: Patient Satisfaction

Perhaps the most dramatic point of comparison was patient satisfaction. None of the Roux-en-Y bypass patients reported being unsatisfied or regretting their surgery, and 80% of them were very satisfied, compared to only 46% of the gastric band patients (9).

Gastric Bypass vs Lap Band:
A Clinical Comparison

The sole research study that directly compared the two procedures through a randomized clinical trial found that bypass patients lost 51% of their excess weight in the first year following surgery, while gastric band patients lost 35% of their weight.

After five years, the results remained similar (67% and 47% respectively).

Only one bypass patient failed to lose any weight, while 9 out of 26 gastric band patients lost no weight.

12% of the Roux-en-Y gastric bypass patients needed repeat surgery, while 15% of the laparoscopic adjustable gastric banding patients required further operations.

There were no deaths reported in either group.

Gastric Bypass vs Lap Band:
Making the choice

Dr. Tice and his team conclude that both the gastric bypass and the gastric band weight loss surgery procedures are relatively safe. They believe Roux-en-Y gastric bypass surgery yields consistently better results than laparoscopic adjustable gastric banding in terms of both weight loss and related health improvements.

However, it's possible that the decreased short term complications of gastric banding and the fact that it's a less invasive surgery (and even reversible) may make stomach banding a better choice for some people.

How successful you are after weight loss surgery is ultimately up to you.

Deciding between lap band vs gastric bypass is a personal decision. However, make sure you make an informed decision. There is no right or wrong answer.

Either surgery is simply a tool that can help you lose weight. What you choose to do with your given tool is up to you. There is no guarantee.

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References

  1. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002 Oct 9;288(14):1723-7.
  2. Williamsom DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C. Prospective Study of Intentional Weight Loss and Mortality in Never-Smoking Overweight US White Women Aged 40–64 Years. American Journal of Epidemiology. 1995 141(12):1128-1141.
  3. Bennett W. Dietary treatments of obesity. Ann N Y Acad Sci. 1987;499:250-63.
  4. Arterburn D, Noel PH. Extracts from “clinical evidence”. Obesity. BMJ. 2001;322:1406-1409.
  5. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737.
  6. Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008 Oct;121(10):885-93.
  7. Cottam DR, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg. 2006;16:534-540
  8. Weber M, Muller MK, Bucher T, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. Dec 2004;240:975-983.
  9. Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg. 2006;141:683-68.

Information for this article was provided by Matt Papa. A medical researcher at Washington University in St. Louis, MO, Matt has taken a special interest in the field of obesity treatment. His concern for people struggling with their weight and for whom diet and exercise have not been effective has given him a desire to translate into layman's terms newsworthy information about weight loss surgery.

In his website Matt discusses the latest research findings on a variety of weight loss related topics including gastric bypass revision and provides information about the Realize My Success website, a post-operative support tool for gastric bypass and sleeve gastrectomy patients.